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Fostering soft skills is a must for nurse leaders


It’s uncommon for nurse leaders to have to coach employees on clinical skills, but quite common for nurse leaders to coach and even use disciplinary action for employees who have problems with communication, teamwork, decision making, and critical thinking skills, all of which are considered soft skills — essential components of emotional intelligence (EI).

Nurse leaders need to consider soft skills along with clinical skills when interviewing nurses for potential employment. Leaders also need to ensure that they, as well as their nurses, develop and possess soft skills to provide safe and competent patient care and to ensure the success of the healthcare institution.

Value of soft skills

According to Goleman, the originator of EI, leaders who have effective self-awareness, self-regulation and motivation, empathy, and social skills have EI. The better you are at using these soft skills, the more success you will most likely have in leading and managing others.

While employers should look for soft skills when hiring new employees, the Society for Human Resource Management (SHRM) tells us soft skills are even more important for professionals who have been in their jobs for some time. SHRM also notes there is a need for all employees to be proficient with critical thinking, problem solving, leadership, professionalism, work ethic, team work, collaboration, and adaptability. Furthermore, a research study conducted by the Indiana Business Research Center (IBRC) found certifications and degrees are important, but what really counts is a person’s ability to possess the soft skills, which are “a crucial part of fostering a dynamic workforce.”

Depending on the work setting, possessing soft skills will affect everyone involved. For instance, if you’re working in an educational setting, top to bottom leadership, board members, students, parents, and the community are influenced by each other’s use of soft skills. If you’re practicing in a healthcare setting, soft skills affect not only the employer and employee but other interdisciplinary team members as well as patients, families, communities, and the society the nurse practices in. Therefore, it is vital that nursing leaders mentor and create work environments that encourage nurses to develop soft skills, which will enhance the use of both teamwork and collaboration and lead to the ultimate goal of improving patient outcomes.

Defining soft skills

The US Department of Labor names six top soft skills. The table below provides the relevance and importance of nurse leaders to teach and mentor each of these soft skills to nursing staff. The column on the right represents examples of the relevance and importance of each soft skill to nursing practice.

Skill  Nursing relevance and importance 
  • To provide safe and competent patient care
  • To obtain pertinent assessment data
  • To develop a patient plan of care
  • To transfer patient care to other healthcare workers when using hands-off-communication
  • To provide patient education
  • To convey the mission and vision of the healthcare institution
  • To motivate staff to achieve excellence in patient care
  • Positive attitude increases patient and staff satisfaction
  • Creates an environment open to improvement and positive change
  • Interdisciplinary patient care necessary
  • Increases efficiency in a often busy healthcare environment
  • Improves staff satisfaction
  • Offers increased opportunity for learning, support, and enhanced professionalism 
Problem solving and critical thinking
  • Necessary to provide safe and competent nursing care in a healthcare system faced with increased patient acuity and multiple chronic illnesses, economic challenges, limited resources, rapid technology advances, and reimbursement constraints
  • Patients often have increased acuity and multiple chronic illnesses
  • Maintain integrity of the profession of nursing
  • Maintain professional licensure
  • Represent the healthcare institution reputation
  • Promotes public and patients trust in nursing profession

Soft skills are congruent with nursing standards. According to AACCN Standards for Establishing and Sustaining Healthy Work Environments: A Journey for Excellence, a healthy work environment is “imperative to ensure patient safety, enhance staff recruitment and retention and maintain an organization’s financial viability.” The table below shows how the AACN standards, which are essential to create and sustain healthy healthcare environments, align with soft skills.

AACCN Skill  Soft skill/emotional intelligence 
Skilled communication Effective communication
Meaningful recognition Enthusiasm, positive attitude
True collaboration Teamwork, networking
Effective decision making Problem solving, critical thinking
Authentic leadership Professionalism, integrity

Soft skills and patient satisfaction

Nurse leaders today work in a variety of healthcare and educational settings, and each setting can be adversely affected by both employers and employees who do not master both EI and soft skills. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) uses patient surveys to provide data on the patients’ perspective of their hospital care, improve quality of care, and enhance the hospital’s accountability of the care provided; hospital reimbursement will be affected by the patient’s responses.

Unfortunately, with the high demands on healthcare institutions many patient survey responses may lead to lower reimbursements to hospitals. Therefore, EI is even more essential for healthcare workers to possess because healthcare institutions cannot afford to lose any more reimbursement dollars than they currently do. While the HCAHPS survey assesses the patients’ perception of their healthcare experience, it does little to assess the nurses’ clinical skill. Rather, it is used to assess the nurses’ soft skills. Included in the core survey questions are how well nurses communicated with patients and how responsive nurses were to the patients’ needs — both questions assess soft skills and EI showing communication, empathy, social skills, commitment, and integrity of the nurse. Hospitals receive highest credit for the response “Always” on the survey. A few of the HCAHPS survey questions include:

1. During this hospital stay, how often did nurses treat you with courtesy and respect?
1. Never
2. Sometimes
3. Usually
4. Always

2. During this hospital stay, how often did nurses listen carefully to you?
1. Never
2. Sometimes
3. Usually
4. Always

3. During this hospital stay, how often did nurses explain things in a way you could understand?
1. Never
2. Sometimes
3. Usually
4. Always

4. During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
1. Never
2. Sometimes
3. Usually
4. Always
5. I never pressed the call button

Nurse leaders are instrumental in educating staff about the importance of HCAHPS survey scores and how closely the survey questions align with effective soft skills and EI. However, nurses must be provided with strategies to learn and practice soft skills and EI. According to the Department of Labor, soft skills cannot be simply taught; they need to be introduced, developed, refined, practiced, and even reinforced to be effectively implemented.

Learning soft skills

Soft skills need to be taught and refined not only in the healthcare setting, but early on in nursing schools. In fact, the US Department of Labor found a large percentage of today’s adolescents lack soft or applied skills such as teamwork, decision-making, and communication needed to enter the workforce.

Soft skills can be learned, but not in a single course; there has to be a broader focus that includes leading by example. For example, nurse leaders can role model and mentor soft skills by performing certain actions on the nursing units such as using good communication technique. Nursing leadership needs to provide training programs that teach soft skills identified by both AACN and the Department of Labor to create work environments in which patients, nurses, and the healthcare institution can thrive. Education programs help staff develop, practice, and refine the use of soft skills.

Before hiring nurse leaders, executives need to assess not only leadership credentials but how the nurse leader communicates, collaborates, and makes decisions in an interdisciplinary team environment and in situations that often can be stressful and chaotic.

The first step in fostering soft skills in employees is for nurse leaders to assess their own soft skill knowledge and use. For instance, nurse leaders should role model and use soft skills effectively in every day nursing practice in front of the nursing staff so that staff see leaders leading by example. Nurse leaders can role model by keeping open lines of communication with staff, being enthusiastic, having a positive attitude, and involving staff in team work, especially with teams that require problem solving and the application of critical thinking skills. For example, when an issue arises on a nursing unit, the nurse leader can work with them as part of the team and role model soft skills and EI.

Recently on a hospital unit, there was an issue with a patient who was dissatisfied with his care and the patient threatened to sign out against medical advice (AMA). The patient had a cardiac problem and was scheduled for open-heart surgery in the morning. The nurse manager, who was busy trying to reach a report deadline, overheard the patient yelling about being dissatisfied with his care and threatening to sign out AMA. At first, the manager debated letting the patient’s nurse handle the issue but decided to help the nurse calm the patient and communicate the need for him to remain in the hospital. The nurse manager took an opportunity to role model soft skills and EI by effectively communicating, using teamwork, and applying problem solving and critical thinking while showing a positive empathetic attitude to not only the patient but to the unit nurse. This nurse leader recognized the importance of both role modeling and mentoring soft skills on the unit.

Unfortunately, this is not always the case among nurse leaders. For instance, on another hospital unit the nurse manger possesses strong clinical skills and often helps the staff when they are short staffed; however, when confronted with any disagreement, this manager often communicates in an irritated and frustrated manner and will even yell at nursing staff. It is not uncommon that both unit nurses and nurse leaders will benefit from soft skill training.

Care plan for nurse leaders

As with nurses developing plans of care for their patients, nurse leaders need to develop a plan of care to encourage and foster soft skills and EI in the healthcare setting. A nursing diagnosis should identify the problem related to soft skills and what evidence or signs exist. For example a nursing diagnosis can be: “Knowledge deficient related to lack of understanding the meaning and importance of soft skills and EI in the healthcare setting as evidenced by low patient satisfaction scores.” Once the diagnosis has been made, it is time to develop the plan of care. A goal of the plan of care is: “The hospital will show improved patient satisfaction scores as evidenced by the HCAHPS survey scores.” Interventions with rationales need to be developed specific to each healthcare facility in order to develop and implement an effective educational program.

Nurse leaders should include the following interventions in the plan of care: acknowledge the importance of soft skills and EI, analyze how soft skills impact the healthcare organization, and research the specific soft skills and EI that staff need to improve. Once nursing leadership addresses these interventions, it is time to develop an educational program for staff. Teaching and role playing soft skills and explaining how each one of these skills is vital to both patient satisfaction and the sustainability of the healthcare institution are essential to the success of the program.

The educational program should include a soft skill competency to evaluate the following: the educational programs effectiveness, skills requiring improvement, and written guidelines for staff expectations.

Taking action

Nurse leaders must be authentic leaders to foster soft skills and truly make a positive difference in the healthcare organization’s future. By considering not just a nurse’s educational degree, certifications, and specialties but also his or her ability to use soft skills, nurse leaders can promote the success of the entire healthcare organization—and foster excellent patient outcomes.

Selected references

American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Health Work Environments: A Journey to Excellence. 2005.

Caudron S. The Hard Case for Soft Skills. Workforce. 2011. http://www.workforce.com/articles/the-hard-case-for-soft-skills

Centers for Medicare & Medicaid Services. HCAHPS: Patients’ Perspectives of Care Survey. 2014. www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html

Goleman D. Working With Emotional Intelligence. New York, NY: Bantam Books; 1998.

Goleman, D. What Makes a Leader? Harvard Business Review. 2004. http://hbr.org/2004/01/what-makes-a-leader/ar/1

National Association of Colleges and Employers. The skills and qualities employers value most in their new hires survey. 2014. http://wp.wpi.edu/employer-news/2014/07/07/nace-the-qualities-and-skills-employers-value-most-in-new-hires/

HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems. 2014. http://www.hcahpsonline.org/home.aspx

Kahn J. (2013). Can emotional intelligence be taught? New York Times. September 11, 2013. www.nytimes.com/2013/09/15/magazine/can-emotional-intelligence-be-taught.html

Indiana Business Research Center. The Demand for Soft Skills: Key Skills for Indiana’s Growing Occupation through 2014. www.incontext.indiana.edu/2007/september/1.asp

McQueen A. (2004). Emotional intelligence in nursing work. J Adv Nurs. 2004;47(1):101-8.

O’Neil J. (2013). Leadership perspectives: advancing the nursing profession begins with leadership. J Nurs Admin. 2013;43(4):179-81.

Rao R. Emotional Business Inspiring Human Connectedness to Grow Earnings and the Economy. Bloomington, IN: iUniverse; 2012.

Salpeter M (2013). 5 soft skills to showcase in an interview. US News and World Report. 2013. http://money.usnews.com/money/blogs/outside-voices-careers/2013/03/20/5-soft-skills-to-showcase-in-an-interview

Smith K., Profetta-McGrath J, Cummings G. (2009). Emotional intelligence and nursing: an integrative literature review. Int J Nurs Studies. 2009;46(12):1624-36.

United States Department of Labor. Soft Skills to Pay the Bills—Mastering Soft Skills for Workplace Success. www.dol.gov/odep/topics/youth/softskills/softskills.pdf

Maureen Kroning is an associate professor of nursing at Nyack College School of Nursing in Nyack, New York.

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